单倍型造血干细胞移植改善难治/复发急性白血病的预后

Haplotype Hematopoietic Stem Cell Transplantation Improving Prognosis Of Refractory/Relapsed Acute Leukemia

目的单倍型移植可产生较强的移植物抗白血病(GVL)效应,观察半倍型造血干细胞移植能否提高难治/复发白血病的生存率。方法本研究选取2012年11月至2018年3月51例难治复发儿童和成人白血病的单倍型移植的患者,病例是连续发生无选择的病人。包括急性髓性白血病、骨髓增生异常综合征与急性淋巴细胞白血病三种,其中急性髓性白血病与急性淋巴细胞白血病中包括十四岁以下儿童,存在父母供者、子女供者、兄妹供者。HLA抗原中存在5/10相合与6/10相合。病患年龄跨度较大,同时所有病人均使用加强的清髓性预处理方案。结果移植后+30天骨髓评估100%完全缓解,预处理期间无药物毒性相关死亡。aGVHD Ⅰ度12/51,Ⅱ度11/51,Ⅲ度1/51。慢性GVHD-广泛性存在5/48,局限性存在27/48。移植相关死亡存在6/51,其中存有复发死亡、肺炎、间质性肺炎。无病生存率45/51。结论单倍型造血干细胞移植可明显改善难治复发急性白血病预后,Ⅲ-Ⅳ的aGVHD发生率低,移植相关死亡率低,而无病生存得到提高,为难治复发白血病的患者带来希望。

Objective Haplotype transplantation can produce strong graft anti-leukemia (GVL) effect,and observe whether half-ploid hematopoietic stem cell transplantation can improve survival rate of refractory/relapsed leukemia.Methods We chose 51 cases of refractory and relapsed childhood and adult leukemias patients with haplotype transplantation from November 2012 to March 2018,who were consecutive with no choice,including acute myeloid leukemia,myelodysplastic syndrome and acute lymphoblastic leukemia.Among them,acute myeloid leukemia and acute lymphoblastic leukemia include children under fourteen,with parental donors,child donors,and sibling donors.There were 5/10 matches and 6/10 matches in HLA antigens.Patients have large age span,and all cases received enhanced myeloablative pretreatment program.Results Bone marrow assessment was 100% completely relieved +30 days after transplantation,and there was no drug toxicity-related death during pretreatment.aGVHD Ⅰ degree was 12/51,Ⅱ degree was 11/51,Ⅲ degree was 1/51.Chronic GVHD had extensive 5/48,localized 27/48.There were 6/51 transplant-related deaths,including recurrent deaths,pneumonia,and interstitial pneumonia,with disease-free survival rate of 45/51.Conclusion Haplotype hematopoietic stem cell transplantation can improve prognosis of refractory and relapsed acute leukemia significantly,with low aGVHD incidence of Ⅲ-Ⅳ,low transplant-related mortality,and improved disease-free survival,which brings hope to patients with refractory and relapsed leukemia.